7.4.1  When to start using an IUCD

An IUCD is usually inserted during a menstrual period, when the cervix is slightly open and pregnancy is least likely. There is, however, a greater chance of expulsion if a device is introduced early in the cycle, because the uterus can squeeze the device back out. Therefore, the best time for insertion is just after a period. However, an IUCD may be inserted at any time. Table 7.1 shows the best timing for IUCD insertion for women in different situations.

Table 7.1  Time of IUCD insertion.

Woman’s situationWhen to start
Having menstrual cycles

• Any time within the first 12 days after the start of menstrual bleeding, preferably after bleeding has stopped, at the woman’s convenience.

• Any other time during the menstrual cycle (not just during menstruation) if the woman is not pregnant and has a healthy uterus.

• If a woman has been using a reliable contraceptive, or has not been having sex, the best time to insert her IUCD is when she asks for it.

After childbirth

• During a hospital or health centre stay following childbirth, if she has decided voluntarily in advance. The IUCD is best inserted within ten minutes of delivery of the placenta.

• It can be inserted at any time within 48 hours after childbirth (special training is required).

• If not immediately after childbirth, then as early as four weeks after childbirth for Copper T IUCDs, such as TCu-380A. At least six weeks after childbirth for other IUCDs.

After miscarriage or abortion

• Immediately, if no infection is present.

• If an infection is present, treat it and help the client choose another effective method.

• The IUCD can be inserted after three months, if no infection remains and re-infection is not likely, and the woman is not pregnant.

Lactating mothers with lactational amenorrhoea (LAM)

• Any time, providing the mother is not pregnant.

When stopping another method

• Immediately.

7.4  Insertion and removal

7.4.2  Checking the IUCD